• Posted August 26, 2024

New Approach Helps More People With Rectal Cancers Avoid Surgery

Giving chemo and radiation therapies before a surgery for rectal cancer can help eliminate the need for removal of the rectum altogether, a new Swedish study finds.

“If the tumor disappears completely during treatment, surgery is not required," said study lead author Bengt Glimelius, a professor of oncology at Uppsala University.

That means both "avoiding surgery and retaining normal rectum and rectal function," he added in a university news release. "Moreover, there are fewer metastases."

The findings are published in the September issue of eClinicalMedicine.

Rectal cancer is relatively common, with about 46,220 new cases diagnosed in the United States each year (27,330 in men and 18,890 in women), according to the American Cancer Society. Deaths from rectal cancer are included in statistics for colorectal cancers (colon or rectum), which kill more than 54,000 Americans annually.

As the Swedish team explained, surgery to remove the affected part of the rectum is often performed soon after a cancer is diagnosed.

Of course, that can lead to difficulties with bowel movements and a need for surgery to divert fecal matter to a colostomy bag, all of which can seriously impair a survivor's quality of life.

During the typical treatment of rectal cancer "patients often first receive radiotherapy or a combination of radiotherapy and concurrent chemotherapy for five weeks, followed by surgery and usually an additional round of chemotherapy for up to six months," the research team explained in a university news release.

Glimelius' team tried a different tack: Give patients all of the chemo and radiation first, before a scheduled surgery.

The new study involve 461 Swedish rectal cancer patients. They got one week of radiotherapy followed by more than four months of chemotherapy, prior to any surgery.

The results were impressive, Glimelius said.

One previous trial had found that, after the traditional approach (a shorter amount of chemo/radiation), the rectal tumor disappeared in just 14% of cases, eliminating the need for surgery.

With the newer approach -- involving a much longer time receiving treatment before a surgery -- the rate at which the tumor disappeared doubled, to 28% of cases.

Leaving the rectum intact didn't raise the odds for cancer's return.

According to Glimelius, the new approach helped cut the need for surgery "but without an increase in local [tumor] recurrence rate after almost five years of follow-up."

Retention of a functioning rectum provides patients with a huge boost in their quality of life, Glimeius explained.

"The rectum is preserved and the need for a stoma [colostomy] and a new rectum is eliminated," he said. "When part of the rectum is surgically removed, the new rectum does not quite understand that it should be able to refrain from frequently sending a signal to the brain that you need to use the toilet."

More information

Find out more about rectal cancer at MD Anderson Cancer Center.

SOURCE: Uppsala University, news release, Aug. 14, 2024